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目的观察一种新的血浆置换液组合在高粘滞综合征血浆置换(PE)术中的临床效果及安全性。方法运用CS3000plus及COM.TEC血细胞分离机对67例高粘滞综合征患者进行了109例次PE。置换液组合选用0.9%生理盐水500ml+低分子右旋糖酐500ml+6%羟乙基淀粉500ml+5%白蛋白生理盐水溶液500ml,PE术后补充同型新鲜冰冻血浆(FFP)400～600ml。每位患者在治疗一个疗程中1～3周进行1～4次PE、每次间隔时间为2～7d。PE术中观察枸橼酸盐中毒、低血容量反应和过敏反应等主要不良反应。PE一个疗程后检测患者外周血中IgG或IgM下降的程度及评价头痛、胸闷、视力模糊、出血倾向和雷诺氏征等主要临床症状的改善情况。结果PE术中主要不良反应的总发生率较低、仅为7.3%,其中枸橼酸盐中毒、低血容量反应和过敏反应的发生率分别为4.6%、1.8%和0.9%。PE一个疗程后,多发性骨髓瘤患者的IgG平均水平从81.9g/L降至38.5g/L(P<0.05),原发性巨球蛋白血症患者IgM平均水平从41.2g/L降至23.4g/L(P<0.05);头痛、胸闷、视力模糊、出血倾向、和雷诺氏征的发生率较治疗前均明显下降(P<0.05)。结论这种新的置换液组合经济、安全、有效并显著减少了新鲜冰冻血浆的用量,值得临床推广应用。
Objective To observe the clinical effect and safety of a new combination of plasma exchange in the treatment of hyperviscosity syndrome (PE). Methods Sixty-seven patients with hyperviscosity syndrome were treated with CS3000plus and COM.TEC blood cell separator for 109 cases of PE. Replacement fluid combination of 0.9% saline 500ml + low molecular dextran 500ml + 6% hydroxyethyl starch 500ml + 5% albumin physiological saline 500ml, PE supplemented with the same type of fresh frozen plasma (FFP) 400 ~ 600ml. Each patient in the treatment of a course of 1 to 3 weeks for 1 to 4 PE, each time interval of 2 ~ 7d. PE surgery observed citrate poisoning, hypovolemic reactions and allergic reactions and other major adverse reactions. PE after a course of treatment to detect patients with decreased levels of IgG or IgM in peripheral blood and evaluate the improvement of major clinical symptoms such as headache, chest tightness, blurred vision, bleeding tendency and Raynaud’s sign. Results The overall incidence of major adverse reactions in PE was low, only 7.3%. The incidence of citrate poisoning, hypovolemia and anaphylaxis were 4.6%, 1.8% and 0.9% respectively. After one course of PE, the average IgG level in patients with multiple myeloma dropped from 81.9 g / L to 38.5 g / L (P <0.05), and the mean level of IgM in patients with primary macroglobulinemia dropped from 41.2 g / L 23.4g / L (P <0.05). The incidence of headache, chest tightness, blurred vision, bleeding tendency and Raynaud’s syndrome were significantly lower than those before treatment (P <0.05). Conclusion This new replacement fluid combination is economical, safe, effective and significantly reduces the amount of fresh frozen plasma, which is worthy of clinical application.